Results

The study enrolled 180 patients, with 45 individuals assigned to each group, in adherence to the principles of the Consolidated Standards of Reporting Trials (CONSORT) and the Declaration of Helsinki, as illustrated in Fig. 1.

The recall rate was 100%, with no exclusions or loss to follow-up. There were no significant differences among the groups regarding demographic characteristics (Table 1) or preoperative pain levels (Table 2).

Fig. 1: The consolidated standards of reporting trials flow diagram

 | Group | P value
Group A | Group B | Group C | Group D
Count | Column N % | Coun | Column N % | Coun | Column N % | Coun | Column N %
Sex | male | 21 | 46.7% | 15 | 33.3% | 17 | 37.8% | 18 | 40.0% | 0.67
female | 24 | 53.3% | 30 | 66.7% | 28 | 62.2% | 27 | 60.0% | 
Age | Mean | Standard Deviation | Mean | Standard Deviation | Mean | Standard Deviation | Mean | Standard Deviation | 
33.20 | 5.00 | 33.40 | 4.88 | 33.18 | 4.63 | 36.07 | 4.48 | 0.84

Time interval | Group A | Group B | Group C | Group D | P value
Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD | 
6 h before | 7.00 / 10.00 (8.00) | 8.44 ± 0.97 aA | 7.00 / 10.00 (8.00) | 8.49 ± 1.1aA | 7.00 / 10.00 (8.00) | 8.18 ± 1.17 aA | 7.00 / 10.00 (8.00) | 8.44 ± 0.99 aA | 0.34
6 h after | 7.00 / 8.00 (7.00) | 7.40 ± 0.50 aA | 4.00 / 7.00 (5.00) | 4.78 ± 0.85 bB | 3.00 / 6.00 (5.00) | 4.51 ± 1.08 bB | 5.00 / 7.00 (6.00) | 6.16 ± 0.88cB | < 0.0001*
24 h | 5.00 / 6.00 (6.00) | 5.67 ± 0.48 aB | 2.00 / 5.00 (2.00) | 2.56 ± 0.66 bC | 0.00 / 3.00 (2.00) | 1.98 ± 1.03 bC | 1.00 / 2.00 (1.00) | 1.24 ± 0.43cC | < 0.0001*
48 h | 3.00 / 4.00 (4.00) | 3.62 ± 0.49 aC | 0.00 / 3.00 (1.00) | 1.18 ± 0.83 bCD | 0.00 / 2.00 (1.00) | 0.80 ± 0.87 bcD | 0.00 / 1.00 (0.00) | 0.27 ± 0.45cD | < 0.0001*
72 h | 2.00 / 3.00 (2.00) | 2.47 ± 0.50 aD | 0.00 / 2.00 (1.00) | 0.56 ± 0.55 bD | 0.00 / 1.00 (0.00) | 0.09 ± 0.29 cD | 0.00 / 0.00 (0.00) | 0.00 ± 0.00cD | < 0.0001*
P value | < 0.0001* | < 0.0001* | < 0.0001* | < 0.0001* | 

Pain intensity differed significantly among groups at all time intervals (P < 0.0001). At 6 h after treatment, Groups B and C showed significantly less pain scores than Group D, with no significant difference between them. Group A showed significantly highest pain scores (P < 0.0001). By, 24 h, Group D achieved the lowest pain scores followed by Group C and Group B and all Groups were significantly lower than Group A. At 48 and 72, the step wise reduction persisted with Group D consistently recording lowest pain levels and Group A maintain highest.

Regarding SP values, a significant difference in absolute SP reduction was observed among groups (P = 0.02). Group C demonstrated the greatest difference, while Groups B and D produced intermediate reductions without significant differences between them.

In terms of percentage change in SP, the difference among groups was highly statistically significant (P < 0.0001). Group C demonstrated the highest percentage of reduction and Group A showed the lowest percentage change, while Group D showed an intermediate reduction, not significantly different from either Group A and B. (Table 3)

Parameter | Group A | Group B | Group C | Group D | P value
Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD | Min / Max (Median) | Mean ± SD
Difference | −3.24 / 343.38 (37.67) | 63.68 ± 90.20 a | 10.66 / 146.33 (37.33) | 50.21 ± 39.60 ab | 6.20 / 270.53 (82.72) | 99.96 ± 85.62 b | 0.59 / 238.13 (43.36) | 52.90 ± 55.79 ab | 0.02*
% of change | −1.40 / 58.90 (17.20) | 19.43 ± 16.76 a | 4.89 / 67.43 (24.60) | 30.62 ± 18.63 b | 14.70 / 74.20 (45.60) | 44.27 ± 18.38 c | 0.50 / 59.40 (24.70) | 27.03 ± 17.29 ab | < 0.0001*

Using Pearsons correlation coefficient, the results demonstrated a moderate-to-strong positive correlation was observed between pain and SP (r = 0.52), which was statistically significant (P = 0.0001), This analysis was based on pain scores recorded 6 h after treatment, indicating a clear association between pain perception and SP vales. (Fig. 2)

Fig. 2: Scatter plot illustrating the correlation between VAS and SP